Cryptorchidism is a condition in which a male infant is born with unilateral or bilateral testicles that do not descend to the scrotum but remain anywhere in their normal descent. This means that there is no testicle in the scrotum or only one side has a testicle.
Normally, as the fetus grows and develops, the testes begin to descend from the retroperitoneal waist and descend into the scrotum in the late fetal stage. If the descent process is obstructed, cryptorchidism is formed. Research results show that the chance of cryptorchidism is 1-7%, among which there are more patients with unilateral cryptorchidism than bilateral cryptorchidism, especially right cryptorchidism. 25% of cryptorchidism is located in the abdominal cavity, 70% stays in the groin, and about 5% stays above the scrotum or other parts. How is cryptorchidism formed? Cryptorchidism is caused by abnormal testicular descent. There are many factors that cause abnormal testicular descent, and the common ones are.
1. Abnormal or absent testicular lead belt that introduces the testicle into the scrotum, so that the testicle cannot descend to the scrotum from its original position.
2, congenital testicular hypoplasia makes the testes insensitive to gonadotropins and loses the power of descent.
3. Luteinizing hormone-releasing hormone produced by the hypothalamus causes the lack of LH and follicle-stimulating hormone FSH secreted by the pituitary gland, which also affects the power role of testicular descent. It has been proved that those caused by endocrine factors are mostly bilateral cryptorchidism, while those caused by other factors are mostly unilateral cryptorchidism.
Sometimes cryptorchidism can be combined with inguinal hernia. What are the health risks of cryptorchidism? The impact of cryptorchidism on health is manifested in two aspects: Firstly, cryptorchidism can affect the growth and development of testicles, thus leading to spermatogenic dysfunction and causing infertility.
Secondly, cryptorchidism can greatly increase the chance of testicular cancer, which is a malignant tumor of the testicles. According to the data, the chance of testicular cancer in patients with cryptorchidism is 40 times higher than that of normal people.
Why does cryptorchidism affect fertility? Experts introduce that testis is the place for human sperm production, and testis is sensitive to temperature, and the suitable temperature for testis to produce sperm is 32-36 degrees C, which is 2-4 degrees lower than normal human body temperature. If the testicles cannot reach the scrotum for various reasons and stay in other parts, the temperature and biochemical environment of these parts are not conducive to the growth and development of the testicles, which will make the testicles underdeveloped or not developed at all, and will not be able to perform the function of sperm production and cause infertility.
How should cryptorchidism patients be treated?
Parents should go to the hospital as soon as they find that your child has no testicles in the scrotum or only one testicle on one side. For children within one year old, it is possible to make the testicles descend into the scrotum through the application of some drugs. If they still cannot descend into the scrotum at the age of two, surgery should be considered. Therefore, cryptorchid descent fixation should be performed before the age of two. In the consultation room of the fertility center of Minquan County Hospital in Shangqiu City, Henan Province, we have met many patients with cryptorchidism who came to the clinic because of infertility, and it can be said that almost all of them are incurable in terms of fertility. In fact, if the parents had found out that their child had cryptorchidism early and treated it in time, there would not have been such a result. But where can we buy the regret medicine? Parents of children with cryptorchidism are advised to take their son to a specialist at an early stage in order to prevent him from becoming a child with infertility in the future.
Treatment method
For children aged 10 months, the luteinizing hormone-releasing hormone (LHRH) preparation Crgptocur can be used as a nasal spray 0,2ng 3 times a day. If the testis still does not drop, we can use chorionic gonadotropin (HCG) 1000 units each time and inject it intramuscularly twice a week for four to five weeks. For adolescent patients with cryptorchidism, testicular descent fixation should be performed as soon as it is detected. If the testicle is found to be atrophied or cannot descend into the scrotum, orchiectomy can be performed if necessary. Is surgery also necessary for unilateral cryptorchidism? Unilateral cryptorchidism patients have one testicle located in the scrotum. In the past, it was thought that the spermatogenic function of this testicle settled in the scrotum was normal and thus would not affect the fertility, but recent studies have found that in unilateral cryptorchidism patients, the descended testicle may not develop normally. On the other hand, the undescended testicles may also become malignant under the high temperature environment, so it is easy to see that unilateral cryptorchidism patients should be treated in time.
Issues to be noted in the treatment of cryptorchidism
The XY gene is an important gene for male sexual characteristics and testicular formation. Endocrine, genetic and physical-mechanical factors can affect the normal descent of the testes.
About 3% of male newborns have “cryptorchidism”, and up to 30% of premature babies. However, most of the affected children will have their testicles descend into the scrotum within a few months or a year after birth under the effect of endocrine factors, and the incidence of cryptorchidism decreases to 0.8% by the age of 1 year. If drug treatment is not effective, surgical treatment can be performed within 2 years of age under the guidance of a doctor.
The following aspects should be noted in the diagnosis and treatment of cryptorchidism.
(1) All male newborns must be examined for the presence of cryptorchidism.
(2) The most accurate examination is in the sitting position with the legs flexed.
(3) If a cryptorchid child shows signs of mental retardation, he or she must also be examined for associated genetic and endocrine abnormalities.
(4) Treatment with human chorionic gonadotropin can be used after 1 year of age.
(5) If endocrine therapy is ineffective, reliable surgical treatment at 2 weeks of age is indicated to free and deliver the spermatic cord, repair the memory hernia sac, and fix the testis in the scrotum.
(6) After the surgical treatment, the patient should be followed up once a year until puberty.
Causes: What causes cryptorchidism?
There are two theories for the causes of incomplete testicular descent.
1. Endocrine factors: If maternal chorionic gonadotropin is insufficient or the testes themselves are defective and do not respond to this hormone, it often causes bilateral testicular descent insufficiency.
2, Mechanical factors: such as short spermatic cord vessels, testicular lead or inguinal canal dysplasia, adhesions between testes and retroperitoneal tissues, testicular muscle variation, etc. impede testicular descent. This condition often causes incomplete unilateral testicular descent.
Symptoms: What are the clinical manifestations of cryptorchidism?
Long-term stay of testes in abnormal position can cause undesirable consequences: 1.
1. Testicular atrophy: If the testicles do not descend into the scrotum, there will be only mild tissue changes within 2 years after birth, but after 2 to 5 years old, it will cause testicular underdevelopment or atrophy. Cryptorchidism on both sides can make 90% of patients infertile.
2.Malignant transformation: The risk of malignant transformation in patients with cryptorchidism is 20 to 48 times greater than that of normal intra-scrotal testes; and the risk of malignant transformation of intra-abdominal testes is 5 times greater than that of inguinal testes. The congenital defect of the testis and the abnormal position of the testis and the high temperature of the surrounding area are the reasons for the malignant transformation of cryptorchidism.
3. Easy to be traumatized: The testicles are located in the scrotum and have a greater mobility, so there is less chance of trauma. The testicles located in the groin, when the abdominal muscle contracts, the inguinal canal also contracts, in which the testicles are squeezed. The testicles in the abdominal cavity are also often squeezed by the change of abdominal pressure.
Testicular torsion: The testicle of cryptorchidism may have abnormal attachment of testicular lead, testicular muscle or testicular sheath, which makes it easy for testicular torsion to occur.
5.Other: About 65% of patients with cryptorchidism have hernia.
6.Empty scrotum may cause low self-esteem, mental distress, and withdrawn temperament.
Examination: What examination should be done for cryptorchidism?
Patients with cryptorchidism often come to the doctor because the scrotum is empty and there is no testicle inside. Some patients also come to the clinic with the complaint of “hernia”, or come for examination because of bilateral cryptorchidism and infertility after marriage. The diagnosis is usually not difficult. However, the differentiation between cryptorchidism, where the testicles cannot be felt, and absence of testicles should be taken seriously, because the latter does not require surgery.
If the patient has XY chromosome, elevated serum follicle stimulating hormone (FSH), decreased serum testosterone (T), and the level of testosterone does not respond to chorionic gonadotropin (HCG) stimulation, the patient has bilateral testicular agenesis (i.e., no testes) and does not require surgical exploration.
For unilateral testicular agenesis, which is difficult to diagnose preoperatively, hormone tests are normal. Gonadal venography, laparoscopy, ultrasound, and CT scan may be helpful for diagnosis, and surgical exploration is still needed if necessary.
Prevention: How should cryptorchidism be prevented?
Parents of boys should check their children’s scrotum carefully. Generally, peanut-sized testicles can be molded on both sides of the scrotum and have a physical sensation when touched. If the scrotum is empty and the testicles cannot be felt, or there is only one, you should go to the hospital immediately. At present, it is believed that surgical treatment of cryptorchidism can be performed after the age of 2, and no later than the age of 10, otherwise it may affect the function of sperm.
Once a child is found to be cryptorchid, he or she must be treated immediately at a specialist in a regular hospital. The methods of treatment include medication and surgery, but whatever the treatment method is, it must be performed within two years of age, because the testicular tissue of the child will undergo pathological changes beyond the age of two.
Dangers of cryptorchidism
The germ cells of children with cryptorchidism are severely inhibited from the second year onwards, and by the time they reach puberty, more than 90% of the intra-abdominal testes have lost their germ cells, 41% in the inguinal testes and 20% in the supra-scrotal testes. Changes in the connective tissue surrounding the testicular tubules in children with cryptorchidism also begin in the second postnatal year. Therefore, no matter unilateral or bilateral cryptorchidism, it should be treated early (10 months of age) to avoid future complications such as fertility, malignant changes and torsion.
The chance of cryptorchidism becoming malignant is 30 to 50 times higher than that of normal testes. About 10% of cryptorchidism including ectopic testes have the risk of malignant transformation, especially the undescended testes in the abdominal cavity may become germ cell tumor. However, it should be noted that cryptorchidism may become malignant even several years after testicular fixation has been performed, so long-term follow-up is needed for patients with cryptorchidism. Secondly, cryptorchidism may cause male infertility due to reduced testosterone production and impaired spermatogenesis. These patients often have decreased blood T and increased FSH and LH, and increased gonadotropin response to GnRH stimulation test, indirectly suggesting the role of endocrine function abnormalities in the development of cryptorchidism. Cryptorchidism often has the risk of combined inguinal hernia and testicular torsion.
Complications of cryptorchidism
Cryptorchidism and infertility. Cryptorchidism has no normal spermatogenic function due to histopathological changes. the higher the position of cryptorchidism and the longer it is above the scrotum, the greater the damage to the testicular varicocele. by Mengel’s observation with a general microscope and electron microscope, patients with cryptorchidism have pathological changes of the varicocele and interstitial cells and significant spermatogenic damage in the testis before the age of 2. Hecker’s examination of normal adults and unilateral Hecker examined the sperm concentration of normal adults and unilateral patients with cryptorchidism after testicular fixation, and the former was significantly higher than the latter, indicating that patients with unilateral cryptorchidism had bilateral cryptorchidism damage. In untreated patients with bilateral cryptorchidism, infertility can reach 100%, and if early treatment is given, fertility can reach 40%. While unilateral cryptorchidism can reach 60% fertility after early treatment. Treatment of patients before the age of 2 years helps to improve the development of spermatogonia and increase the number of spermatogonia and subsequent spermatogenesis. Patients with unilateral and bilateral cryptorchidism have lower than normal spermatogenic capacity in adulthood despite early treatment.
Cryptorchidism and testicular torsion, because there is often abnormal development between the testicle and the tether in cryptorchidism patients, testicular torsion is prone to occur. Rigter reported that 64% of adult cryptorchid testicular torsion occurs due to malignant changes in the testis, resulting in changes in testicular weight and testicular gravitational axis. The treatment principle is testicular fixation or orchiectomy if needed.